Laserfiche WebLink
SAN JOANN Environmental Health Denartment <br />R EC E I ib � SALVADOR BUENROSTRO <br />n es s 7. DBA CALIFORNIA CATERING TRUCK WASH <br />730 S CALFORNIA ST <br />APR 10 2023 STOCKTON, CA 95203 <br />COMMISSARY AGREEMENT <br />ENN IRONNI11N"TALI-IEALTH Mobile Food Facility• Caterer <br />DFIIARINIENT <br />Complete sections 1 and 2. If your commissary is located outside of San Joaquin County also complete section 3 <br />1. To be completed by APPLICANT <br />Business Name THE WING TRUCK Lic. Plate# 4UB4374 <br />Owner/Operator Name BRENDA O SANDIGO <br />Business Mailing Address 815 W. LONGVIEW <br />City STOCKTON State CAZip 95207 Bus. Ph.2098641200 Alt. Ph. 2099490810 <br />I, , hereby state that the above information is current, true and correct to <br />the best of my knowledge and agree to utilize my approved commissary in accordance with California Health & <br />Safety Code, and San Joaquin County Environmental Health Department (EHD) requirements. If the use of the <br />commissary is discontinued, the per Wholder mustnytii�t�the EHD. Failure to notify this office may result in permit <br />revocation ae abnalties. \ � <br />2. To be completed by COMMISSARY OWNER/OPERATOR <br />Commissary Name California Catering Truck Wash FA# 209-464-9707 <br />Address 730 S California St Bus. Phone 209-271-1741 <br />City Stockton Zip 95203 Owner/Operator Salvador Buenrostro & Carmen Rivera <br />Check all appropriate services provided <br />12 Wastewater disposal G7 3 -compartment sink 0 Electrical hook-ups <br />6 Solid waste disposal 9 Food preparation Ck Toilet and handwashing <br />® Hot & Cold water for cleaning U Store refrigerated food 17 Potable water <br />® Store dry food/supplies U Overnight parking 17 Vehicle wash <br />I, , hereby state that the information I have provided is current, true and <br />correct to the best of my knowledge, and meets the California Health & Safety Code requirements. If the food facility <br />operator fails to comply with the conditions of this agreement, or if this agreement is modified or cancelled, the <br />commissary owner shell notify the EHD imTpdiately. <br />4/10/23 <br />1 3. To be completed by the ENV HEALTH iurisdiction outside of San Joaquin Co. <br />The commissary is located in County. The above food facility meets the <br />commissary requirements in California Health & Safety Code. The above checked services are available at the <br />above commissary. Please notify EHD if the status of their operating permit changes. <br />REHS Signature <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br />